Provider Demographics
NPI:1992559355
Name:ALSTON, GARY MICHAEL
Entity type:Individual
Prefix:MR
First Name:GARY
Middle Name:MICHAEL
Last Name:ALSTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:GARY
Other - Middle Name:MICHAEL
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6791 WOODBRIDGE WAY APT 201
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28314-1990
Mailing Address - Country:US
Mailing Address - Phone:910-224-7477
Mailing Address - Fax:
Practice Address - Street 1:6791 WOODBRIDGE WAY APT 201
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28314-1990
Practice Address - Country:US
Practice Address - Phone:910-224-7477
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-12
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No172V00000XOther Service ProvidersCommunity Health Worker